Institute for Women's Health, University College London, London, UK.
Department of Psychology, University of Warwick, Coventry, UK.
Arch Dis Child Fetal Neonatal Ed. 2022 Jul;107(4):408-413. doi: 10.1136/archdischild-2021-322888. Epub 2021 Oct 25.
To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006.
Prospective cohort studies.
School or home-based assessments at 11 years of age.
Available data for 88 EP children born before 26 weeks of gestation in 2006 (EPICure2) were compared with those of 140 born in England during 1995 (EPICure). To account for social secular trends, the comparison between eras was also made for term-born controls as reference.
HRQL was measured using the parent-completed Health Utilities Index (HUI) questionnaire with utility scores calculated using the HUI3 classification system. Eight attributes were assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain.
At 11 years, mean utility scores were significantly lower in EPICure2 (2006) than in EPICure (1995; Δ -0.12, 95% CI -0.20 to -0.04). The difference increased (Δ -0.27, 95% CI -0.41 to -0.12) after adjusting for significant perinatal and demographic differences between cohorts. Rates of suboptimal function were increased in EPICure2 for all eight attributes, but statistically significant differences were only found in speech (p=0.004) and dexterity (p=0.020). After excluding children with severe neurodevelopmental impairment, the adjusted difference between cohorts remained significant but attenuated (-0.14 (-0.26 to -0.01)). Mean utility scores for controls were similar between cohorts (Δ -0.01 (-0.04 to 0.02)).
Using parent report, there was a clinically significant decline in HRQL ratings for EP children over time. Areas contributing the most to the decline were speech and dexterity.
ISRCTN86323684.
比较英格兰两个时期（1995 年和 2006 年）极早早产（EP）出生在 26 周前的儿童的健康相关生活质量（HRQL）。
前瞻性队列研究。
11 岁时在学校或家中进行评估。
2006 年 EPICure2 研究中可获得的 88 名 26 周前出生的 EP 儿童的数据与英格兰 1995 年出生的 140 名 EP 儿童（EPICure）的数据进行了比较。为了说明社会的长期趋势，还将这两个时期的足月出生对照组进行了比较。
使用父母完成的健康效用指数（HUI）问卷测量 HRQL，使用 HUI3 分类系统计算效用评分。评估了 8 个属性：视力、听力、言语、运动、灵巧性、情绪、认知和疼痛。
在 11 岁时，EPICure2（2006 年）组的平均效用评分明显低于 EPICure（1995 年）组（Δ-0.12，95%CI-0.20 至-0.04）。调整两组间围产期和人口统计学差异后，差异增加（Δ-0.27，95%CI-0.41 至-0.12）。在 EPICure2 组，所有 8 个属性的功能障碍发生率均增加，但言语（p=0.004）和灵巧性（p=0.020）的差异有统计学意义。排除严重神经发育障碍的儿童后，两组间的调整差异仍然显著，但减弱（-0.14（-0.26 至-0.01））。对照组的平均效用评分在两组间相似（Δ-0.01（-0.04 至 0.02））。
使用父母报告，EP 儿童的 HRQL 评分随时间推移有临床意义的下降。对下降贡献最大的领域是言语和灵巧性。
ISRCTN86323684。
